Rheumatoid arthritis with fracture femur managed with three-in-one femoral nerve block

Rheumatoid arthritis (RA) can be defined as chronic polyarthritis affecting mainly the peripheral joints, running a long course with exacerbations and remissions, and also accompanied by a generalized systemic disturbance. Anesthetic risks in osteoarticular disorders involve not only the mechanical deformities caused by the diseases but also their cardiovascular, respiratory, renal, and digestive systemic effects. Whenever possible, surgery should be performed under regional anesthesia, the advantages of which include avoidance of airway manipulation and polypharmacy related to general anesthesia. The “3-in-1 block” entails injection of large volume of local anesthetic around the femoral nerve with resultant blockade of the obturator, femoral, and lateral cutaneous nerves of the thigh. Here, we report a case of fracture neck of femur with coexisting RA and hypertensive disorder managed with three-in-one femoral nerve block.